Community Health Workers and teleaudiology as a culturally-relevant approach to improving access to hearing health care

许多农村和资源不足的地区缺乏听力服务，加剧了听力保健方面的差距。在……里面 在美国，估计有5000万65岁及以上的人受到听力损失的影响。进入 助听器康复可以改善健康状况，但听力专家的地理分布不均衡 在美国各地造成了缺乏服务的社区。在目的听力学中，听觉学家向 通过视频会议技术从远程工作场所就诊，最大限度地减少地理位置的障碍。 有证据表明，目的听力学在临床上等同于面对面的程序，包括在 助听器试戴和验证的区域。然而，影响差距的可获得性额外障碍 众所周知，人口，包括社会经济和文化差异，是造成卫生服务不佳的原因之一。 利用率。在目的性听力学中，促进者位于患者现场，在 远程听觉学家的监督。社区卫生工作者可能是一种可行的患者现场支持 远程听力学，因为它们在促进差异人口的健康方面发挥了既定的作用。几十年来， 社区卫生工作者为一些特定疾病(如糖尿病)和一般健康提供了支持 通过提供社区接受的健康教育、患者倡导以及与患者护理相结合 团队。鉴于它们在解决广泛的其他卫生领域的差异方面的既定历史， 社区卫生工作者因其在减少获得卫生服务方面的差距方面的紧急作用而被确认 听力保健(Marrone等人，2017；Marrone，Ingram等人，2016)。拟议的研究建立在 赞助商正在进行的为拉美裔/拉丁裔服务的社区卫生工作者计划的研究 听力受损的老年人。这项拟议的研究旨在测试一种创新方法在 哪些社区卫生工作者充当远程听力学的患者现场支持。假设是这样的 通过目的性听力学提供循证听力学服务，并提供患者现场支持 社区卫生工作者将改善获得护理的机会，从而改善听力健康 结果。在这个项目中，远程助听器配件将由一名听力专家在患者现场提供支持 来自农村地区的一群老年人(65岁)的社区卫生工作者 被认定为听力保健资源不足。助听器的益处将通过以下方式进行量化衡量 标准化的患者报告的结果衡量标准，并通过焦点小组进行定性。我们希望有助听器 与等待名单对照组相比，立即干预组的福利在3个月后得到改善， 并将结果维持在6个月。拟议的研究和培训计划由 多学科研究团队，在听力学、公共领域有着长期的合作历史 健康、远程医疗和社区健康。总体目标与NIDCD的研究优先事项保持一致 为资源匮乏地区提供高质量、可获得的听力保健提供证据。 好了！

Many rural and under-resourced areas lack audiology services, exacerbating hearing health care disparities. In the United States, hearing loss impacts an estimated 50 million individuals aged 65 years and older. Access to hearing aid rehabilitation can improve health outcomes, yet an uneven geographic distribution of audiologists across the U.S. results in communities that lack services. In teleaudiology, an audiologist delivers care to a patient from a remote workplace via videoconferencing technology, minimizing the barrier of geography. Evidence has demonstrated the clinical equivalence of teleaudiology to face-to-face procedures, including in the area of hearing aid fitting and verification. However, additional barriers to accessibility affecting disparity populations, including socioeconomic and cultural differences, are known to contribute to poor health service utilization. In teleaudiology, a facilitator is located at the patient site to assist with hands-on tasks, under the supervision of the remote audiologist. Community Health Workers may be a feasible patient-site support for teleaudiology due to their established role in health promotion for disparity populations. For decades, Community Health Workers have supported a number of disease-specific (e.g. Diabetes) and general health areas by providing community-receptive health education, patient advocacy, and integrating with patient-care teams. Given their established history of addressing disparities in a vast range of other health areas, Community Health Workers have been identified for their emergent role in reducing disparities in access to hearing health care (Marrone et al., 2017; Marrone, Ingram et al., 2016). The proposed research builds on the Sponsors’ ongoing research with an established Community Health Worker program serving Hispanic/Latino older adults with hearing loss. The proposed study aims to test the feasibility of an innovative approach in which Community Health Workers serve as the patient-site support for teleaudiology. The hypothesis is that providing evidence-based audiology services delivered via teleaudiology with patient-site support from Community Health Workers will lead to improved access to care, and therefore improved hearing health outcomes. In this project, remote hearing aid fittings will be delivered by an audiologist with patient-site support from a Community Health Worker for a cohort of older adults (>65 years) from a rural area that has been identified as under-resourced for hearing health care. Hearing aid benefit will be measured quantitatively via standardized patient-reported outcome measures, and qualitatively via focus groups. We expect hearing aid benefit to be improved at 3 months in an immediate intervention group relative to a waitlist comparison group, and for outcomes to be maintained at 6 months. The proposed research and training plans are supported by a multidisciplinary team of researchers with a longstanding history of collaboration across audiology, public health, telemedicine, and community health. The overall goal aligns with the NIDCD research priority to generate evidence for high-quality, accessible hearing health care in under-resourced areas. !